Transcript Slide 1

Paramedic Care: Principles & Practice
Fourth Edition
Volume 3: Patient Assessment
CHAPTER
3
Therapeutic
Communications
Standard
• Assessment
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Paramedic Care: Principles & Practice, 4th Ed.
Competency
• Integrate scene and patient assessment
findings with knowledge of
epidemiology and pathophysiology to
form a field impression.
• This includes developing a list of
differential diagnoses through clinical
reasoning to modify the assessment
and formulate a treatment plan.
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Paramedic Care: Principles & Practice, 4th Ed.
Introduction
• As a paramedic, you must use every
strategy to make sure you understand
your patients and they understand you.
– Word choice, tone of voice, facial
expressions, body language.
• Adjust your communication style to fit
each new situation.
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Paramedic Care: Principles & Practice, 4th Ed.
Introduction
• Sincere desire to be part of helping
profession; understanding of human
strengths and weaknesses; empathy.
• Communication: sender, message,
receiver, feedback.
• Sender: encodes, creates message.
• Receiver: decodes, interprets message.
• Feedback: response to message.
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Introduction
• Failure to Communicate
– Prejudice, or lack of empathy.
– Lack of privacy.
– External distractions.
– Internal distractions.
• Patience and flexibility hallmarks of
good communicator.
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Building Trust and Rapport
When trust established, rapport follows.
Establish positive rapport quickly.
Ask patients the right questions.
Respond with empathy.
With good rapport, people you are
serving will follow your lead.
• Effective communication begins and
ends with trust and rapport.
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Building Trust and Rapport
• Present yourself as caring,
compassionate, competent, confident
health care professional.
• Dress and grooming important.
• Voice, body language, gestures, eye
contact communicate you care about
patient's problems.
• Be aware of your patient's comfort.
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Building Trust and Rapport
• If patient in obvious distress, try to
alleviate his pain or discomfort while
you interview him.
• Introduce yourself.
• Use patient's name.
• Modulate your voice.
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Building Trust and Rapport
• Use professional but compassionate
tone of voice.
• Explain what you are doing, and why.
• Keep a kind, calm facial expression.
• Use the appropriate style of
communication.
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Paramedic Care: Principles & Practice, 4th Ed.
Introduce yourself and use an appropriate compassionate touch to show your concern and support.
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Paramedic Care: Principles & Practice, 4th Ed.
Effective Communication
Techniques
• General Guidelines
– Patients' response to questioning:
 Pour out information easily.
 Reveal some things; conceal others.
 Resist, hiding information.
– Be consistently professional,
nonjudgmental, willing to talk about any
concern.
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Paramedic Care: Principles & Practice, 4th Ed.
Effective Communication
Techniques
• Nonverbal Communication
– Gestures, mannerisms, postures person
uses to communicate with others.
– Distance: socially acceptable distance
between strangers is 4 to 12 feet.
– Relative level: remaining at eye level
indicates equality.
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Interpersonal Zones
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Paramedic Care: Principles & Practice, 4th Ed.
Effective Communication
Techniques
• Nonverbal Communication
– Dropping below eye level helpful when
patient elderly adult or child.
– Open stance: arms extended, open
hands, relaxed large muscles, nodding
head.
– Closed stance: arms flexed, or arms
crossed tightly over chest.
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Getting down to a patient's level can help improve communications on a pediatric call.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Effective Communication
Techniques
• Nonverbal Communication
– While interviewing patient, use eye
contact as much as possible.
– Look at patient frequently.
– Eye contact one way to send message
to patient.
– Nothing builds trust and rapport, or
calms patients, faster than the power of
touch.
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Effective Interviewing Techniques
• Identify patient's chief complaint, learn
circumstances that caused emergency,
determine patient's condition.
• Ask questions, observe patient, listen
effectively, use appropriate language.
• Gather information that is accurate,
complete, relevant to emergency.
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Effective Interviewing Techniques
• Let patient state chief complaint in his
own words.
• Chief complaint should drive all other
questions to be asked.
• Continue to ask open-ended questions.
• Use direct questions when necessary.
• Do not ask leading questions.
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Effective Interviewing Techniques
• Ask only one question at a time; allow
patient to complete his answers.
• Listen to patient's complete response
before asking next question.
• Use language patient can understand.
• Do not allow interruptions, if possible.
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Effective Interviewing Techniques
• Active Listening
– Listen closely to what patients tell you.
– Do not develop tunnel vision from
dispatch information.
– Begin assessment without any
preconceived notions.
– Watch for subtle clues patient may not
be telling truth.
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Effective Interviewing Techniques
• Listening is an active skill, not a
passive one.
• Requires your complete attention.
• Focus on the messenger.
• Watch for clues to important signs,
symptoms, emotions.
• Modify questions to follow clues.
• Provide feedback to confirm you have
understood message correctly.
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Effective Interviewing Techniques
• Feedback Techniques
– Silence
– Reflection
– Facilitation
– Empathy
– Clarification
– Confrontation
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Effective Interviewing Techniques
• Feedback Techniques (cont'd)
– Interpretation
– Asking about feelings
– Explanation
– Summarization
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Effective Interviewing Techniques
• Common Errors
– Providing false assurances.
– Giving advice.
– Abusing authority.
– Using avoidance language.
– Distancing.
– Using professional jargon.
– Talking too much; interrupting.
– Using “why” questions.
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Effective Interviewing Techniques
• Observing Your Patient
– Observe patient during interview.
– Note appearance, level of
consciousness, body movements.
– Be aware of defense mechanisms.
– If indication patient's hostile behavior
may threaten your safety or crew,
maintain distance and exit path.
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Effective Interviewing Techniques
• Using Appropriate Language
– Most patients will not understand
medical terms.
– Use appropriate level of questions; do
not appear condescending.
– Barriers to communication: cultural and
language differences, deafness, speech
impediments, blindness.
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Special Needs and Challenges
• Start interview in usual manner.
• Develop rapport by reviewing reason
dispatch gave for call.
• Attempt to ask open-ended questions.
• If unsuccessful, try direct questions.
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Special Needs and Challenges
• Provide positive feedback.
• Be sure the patient understands
questions.
• Rule out language barriers, hearing
difficulties, pathology.
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Special Needs and Challenges
• Children
– Effective communication with pediatric
patients depends on their age.
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Childhood Development by Age
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Childhood Development by Age
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Special Needs and Challenges
• Children
– Start by talking to caregivers.
– Gradually approach patient.
– Get down to child's eye level.
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Special Needs and Challenges
• Children
– Introduce yourself; use child's name
often; be careful not to clam up.
– Tell child everything: what you are
looking at and why it is important.
– Most important, you must build trust.
– Giving child stuffed toy may be helpful.
– Use straightforward language.
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Paramedic Care: Principles & Practice, 4th Ed.
Special Needs and Challenges
• Children
– More matter-of-fact and informative you
can be, the better.
– Use lots of eye contact; compassionate
touch.
– Ask child for feedback frequently.
– Be aware young children very literal;
word choice important.
– Build trust and rapport with parents.
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Paramedic Care: Principles & Practice, 4th Ed.
Use a small toy to help calm a child.
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Paramedic Care: Principles & Practice, 4th Ed.
Special Needs and Challenges
• Elderly Patients
– Be respectful; use formal means of
address.
– Speak slowly and clearly.
– Interviews might take longer.
– Use compassionate touch.
– Give elderly patient choices whenever
possible.
– Take along their “living assists.”
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Paramedic Care: Principles & Practice, 4th Ed.
Special Needs and Challenges
• Patients with Sensory Impairment
– Blind present special problems.
– Identify yourself immediately.
– Nonverbal communications useless in
these cases.
– Voice and touch only effective tools.
– Ask hearing-impaired and deaf patients
preferred method of communication: lip
reading, signing, writing.
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Paramedic Care: Principles & Practice, 4th Ed.
Special Needs and Challenges
• Angry, Hostile, Uncooperative Patients
– Understand anger is a natural part of
grieving process; may be venting their
frustration.
– Try to accept their feelings without
getting defensive or angry in return.
– Be nonthreatening; avoid confrontation.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Special Needs and Challenges
• Angry, Hostile, Uncooperative Patients
– Set limits and establish boundaries.
– Document unusual situations.
– If blatantly hostile, or your safety is
jeopardized, stay far enough away.
– Monitor patient closely.
– Be sure you have clear path to exit.
– Do not hesitate to call law enforcement.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Special Needs and Challenges
• Sensitive Topics
– Sexual activities, death and dying,
physical deformities, bodily functions,
domestic violence.
– Make the unfamiliar familiar; it will
seem less imposing.
– To earn patient's trust, try to make him
or her feel problem is not uncommon.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Special Needs and Challenges
• Sensitive Topics
– Sexual history taken later during
history; it can be part of present illness
or past history, depending on chief
complaint.
– Remain calm, objective, nonjudgmental,
regardless of how patient answers.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Special Needs and Challenges
• Silence
– If patient suddenly becomes silent, try
to determine why, what is happening,
what you should do about it.
– Stay calm; observe patient's nonverbal
clues.
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Paramedic Care: Principles & Practice, 4th Ed.
Special Needs and Challenges
• Overly Talkative Patients
– Accept less comprehensive history.
– Briefly give patient free rein.
– Focus on important areas.
– Ask closed-ended questions.
– Interrupt frequently; summarize what
he says.
– Try not to become impatient.
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Paramedic Care: Principles & Practice, 4th Ed.
Special Needs and Challenges
• Patients with Multiple Symptoms
– Challenge is to discover chief complaint.
– Sort through multitude of information
quickly; recognize patterns that lead to
correct field diagnosis.
• Anxious Patients
– Anxiety natural reaction to stress.
– Encourage patient to speak freely about
the signs of anxiety.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Special Needs and Challenges
• Patients Needing Reassurance
– Do not be overly reassuring or
prematurely reassure anxious patient.
• Intoxicated Patients
– Irrational, disrupt your control of scene,
rarely allow you to examine them.
– Make sure your environment safe.
– Avoid challenging body language or
remarks.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Special Needs and Challenges
• Crying Patients
– Crying form of venting; clue to patient's
emotions.
– Accept it as natural release; do not try
to suppress it.
• Depressed Patients
– Depression potentially lethal; recognize
its signs and evaluate its severity.
– Ask about suicide risk.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Special Needs and Challenges
• Confusing Behaviors or Histories
– You may encounter patient whose story
you just cannot follow.
– In these cases, problem cannot be
diagnosed in field.
– If patient's behavior seems distant,
aloof, inappropriate, or even bizarre,
suspect mental illness.
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Paramedic Care: Principles & Practice, 4th Ed.
Special Needs and Challenges
• Confusing Behaviors or Histories
– Delirium and dementia disorders
relating to cognitive function.
– Delirium common in acutely ill or
intoxicated patient.
– Dementia occurs frequently in elderly.
– Often cannot provide clear, accurate
histories.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Special Needs and Challenges
• Patients with Limited Intelligence
– Do not assume patient will not be able
to provide accurate information
concerning medical status.
– Try to evaluate patient's education and
mental abilities.
– If you suspect severe mental
retardation, obtain history from family
or friends.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Special Needs and Challenges
• Talking with Families or Friends
– Patients who cannot give useful
information: find third party who can.
– Patient confidentiality priority.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Transferring Patient Care
• When you arrive at scene, EMS-trained
first responders may already be there.
• Before they transfer patient care to
you, listen to their report carefully.
• Integrate information they give you
into questions you ask patient.
• Interact with emergency colleagues
with respect and dignity.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Quickly and effectively gather
information about patient.
• Remember your body language, tone of
voice, facial expressions, how you
position yourself to patient.
• Develop situational communication
templates that you can draw on as
scenarios unfold.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Situations that require assertiveness or
calm, empathetic compassion call for
two different communication styles.
• You will need sensitivity to recognize
and respond to signs of suffering to
create ideal, individualized process of
communication.
• Show compassion and empathy;
demonstrate expertise necessary.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.